Pfa 100: Platelet Function Assay

What impact does the illness have on the blood’s ability to clot? Include the role of vitamin K and the specific clotting proteins affected. Also discuss platelet production. Describe the test that is typically run to test the blood’s clotting ability.

The WBC and platelets are high because the Pt.’s body is trying to fight an infection.

In Cardone presentation, His main focus was on Platelet-rich plasma (PRP), (plasmas that come from the patient’s body, and is centrifuged to increase the concentration of platelets combined with remaining blood). He also discussed the potential advantages as well as potential drawbacks and uncertainties regarding the use of PRP injections to treat

low platelet count and low white blood cell count. In reference to Mr. J.’s symptoms and CBC results additional diagnostic labs were ordered.

October 17, 2009, my world changed. My little brother, Brennan, was diagnosed with idiopathic thrombocytopenia purpura, in short known as ITP. Normally, platelets are made in bone marrow and make their way through the blood stream and filtered out by the spleen. In Brennan’s case, his platelets are destroyed by his body causing his platelet count to drop to life threatening levels. Brennan’s platelet count from 2009, to today in 2016, has never gotten higher than 20,000; which means that he is at risk for spontaneous bleeding at any time. Due to this, Brennan is not allowed to participate in sports and many other physical activities.

The normal platet count is 150,000 to 200,000, but when i was hospitalized my platelet count was at a signicantly low level of 3,000.

Sarah is a 31yo, G3 P1101, who is seen for an ultrasound evaluation and assessment for FTS and a consultation due to her clotting abnormalities. The patient does have a history of a 20 week IUFD and had a full thrombophilia work-up and ended up with several test results that were positive. She is heterozygous for factor V Leiden and heterozygous for prothrombin gene mutation, which is a combination that is a risk factor for thrombosis that is equal to being homozygous for either factor V Leiden or homozygous for prothrombin gene mutation. The patient herself has never had a thrombotic event. She also is heterozygous for MTHFR and PAI 4G/5G positive. She also has a positive anticardiolipin IgG antibody. In her 2nd pregnancy she was treated

Idiopathic Thrombocytopenic Purpura is also known as, primary immune thrombocytopenic purpura, and autoimmune thrombocytopenic purpura, it is a bleeding disorder and manifest as a clinical acute disorder in children, which is short term and chronic disorder, long term in adults. Women are shown to contract this disease two to three times more than men. The key characteristic is the destruction of platelets by the autoimmune system which mistakenly attacks and destroys the body’s platelets, the reason is unknown thus the name “idiopathic’. The onset is linked to viral or bacterial infection which acts as a “trigger”. This disease is not transferable from one person to another.

Rotational Thromboelastometry (ROTEM, TEM Innovations GmbH, Munich, Germany) and thromboelastography (TEG, Haemoscope, Braintree, MA) are whole blood coagulation analyzers that measure viscoelastic changes of the entire clotting process. Compared to the prothrombin time (PT/INR) and partial thromboplastin time (aPTT), which measure coagulation factor function, TEG/ROTEM can evaluate platelet function, clot strength, and fibrinolysis, (de Laz, Nascimento, & Rizoli, 2013). This additional information can help guide resuscitation efforts by classifying bleeding due to coagulopathy. As a result, the need for platelets, cryoprecipitate (fibrinogen, Factor VIII, von Willebrand factor, &

Exclusion criteria for the study included: Patient refusal to consent (absolute), infection in the patients back near the proposed site of the injection, coagulation disorder :-( defined as PT: > 18 sec, PTT: >40 sec, I.N.R: > 1.5, clotting time: >8 min, platelet disorder: platelet count: < 100.000, bleeding time: >4 min, HELLP Syndrome: - (defined as Hemolysis, Elevated Liver enzymes, Low Platelet count), receiving any anticoagulant drugs, preexisting neurological disease or psychic patients, history of cardiac and respiratory system failure, known allergy to local anesthetics drugs, coexisting renal disease and eclamptic patients.

Platelet-rich plasma (PRP) is a patient’s own concentrated platelets. PRP contains a large number growth factors. These growth factors stimulate healing.

To begin this portion of the total blood cell count a finger prick was completed. In order to do this gloves were put on the participant’s hands and the finger being used to prick was thoroughly cleaned with an alcohol pad (allowed to air dry). Next a sterile lancet was used to stick the cleaned finger until blood appeared. Holding the hand down, two capillary tubes were filled at least two thirds of the way full with the participant’s blood. After the capillary tubes were filled they were sealed by pressing the clean end into the clay pad. Both capillary tubes were then placed onto the centrifuge for three minutes to spin, (which separated the elements of blood). The group then used a hematocrit card reader to measure the percentage of red blood cells. To do this the bottom of the capillary tube was placed on the scale at 0 and the top of the plasma at 100. The value at the top of the red blood cell portion indicates the percentage of whole red blood cells. Materials for collecting the white blood cell differential information included three clean glass slides, a sharp, wrights stain, a buffer for wrights stain, bibulous paper, a stacking rack, and a microscope. This experiment also requires a finger prick, if more blood was needed then it was performed again as previously stated. A small drop of blood was placed on two of the three clean slides. The third clean slide was used to smear the blood on each of the slides containing the drop. The slides were to be held flat while the third slide was used to push the blood down the slide in a thin layer. After a thin blood smear was created on both slides the blood was allowed to air dry for the staining process. Following the slides drying, they were placed on a stacking rack with the blood

CBC shows a white count of 7.6, H&H of 13.6 and 41.4, platelet count is 282. Differential is normal. BNP has a sodium of 140, potassium of 4.5, chloride of 106, bicarb of 24, BUN and creatinine of 12 and 1.0 respectively, glucose of 104, osmolality is 289, calcium 9.4. Lipase is 160. Total bilirubin is 0.5. Alk phos 62. AST 27. ALT 9. Albumin 4.4.

,platelet count at cutoff less than 74000 mm3 is significant in prediction of variceal bleeding risk with sensitivity 82.5% and specificity 55%. and platelet count/spleen diameter ratio (PC/SD) at cutoff 851.6 is significant in prediction of variceal bleeding risk with sensitivity 45% and specificity 90%.(table 5)

It includes complete blood count, aPTT, PT, fibrinogen, and clothing fact tests. CBC measures the amount of hemoglobin, number of red cells and whites blood cells along with platelets. CBC is usually normal in a person with hemophilia A. Activated partial thromboplastin time (aPTT) measures how long it takes for blood to clot. It measures the clotting ability of factor XII, XI, IX, VIII and this would be abnormal in a individual with hemophilia A since hemophilia A is associated to factor VIII. Prothrombin time also measure the clotting ability but for factor X, VII, V, II, and I. This would be normal in individuals with hemophilia A. Fibrinogen test helps doctors to assess a patients ability to form a clot. Lastly, clotting factor test also known as factor assay is used to determine the type and the severity of hemophilia. The testing mentioned above is the traditional testing that’s used to diagnose hemophilia